FAQs

Insulinomas FAQs

What is an insulinoma?

An insulinoma is a tumour found on the pancreas and is known as a pancreatic endocrine tumour. These tumours release the hormone insulin which can affect blood sugar levels causing hypoglycaemic (hypos) episodes. Insulinomas can be benign or malignant.

Insulinomas are quite rare and less than 10% are malignant. They are more common in the fifth decade of life and there is a higher incidence in women than men. Approximately 10% have multiple tumours.

Approximately 5% of insulinomas are as a result of MEN1 syndrome.

Could I have MEN1 Syndrome?

Multiple endocrine neoplasia type 1 (MEN1 syndrome is an extremely rare condition caused by a faulty gene which can be inherited and causes a number of tumours to develop in the endocrine system. These tumours can be benign or malignant.

If your consultant suspects that you may have MEN1 you will be offered a blood test to estimate levels of calcium and certain hormones in the blood.

If the condition is confirmed you will be offered genetic counselling and a treatment plan will be designed for you. Arrangements will also be made for your children and siblings to be tested for MEN1.

What is insulin anyway?

Insulin is a peptide hormone responsible for regulating fat and carbohydrate metabolism in the body. Insulin is produced by the pancreas, which lies behind the stomach.

Insulin’s role is to remove excess glucose (sugars) from the blood which could be toxic. Once glucose levels drop to the normal range, insulin release slows down or stops. However insulinomas keep releasing insulin even when your blood sugar drops too low.

High blood insulin levels cause low blood sugar levels (hypoglycaemia or hypos as they are generally known). Hypos may be mild making you feel anxious or hungry or can be severe leading to a loss of consciousness or seizures.

What is Reactive Hypoglycaemia?

The initial symptoms for an insulinoma and reactive hypoglycaemia are the same as for insulinomas. For example a low blood glucose reading.

The key difference between reactive hypoglycaemia and an insulinoma; is with an insulinoma there is a tumour producing insulin which is causing the hypoglycaemia or low blood glucose reading.

In Reactive Hypoglycaemia there is NO TUMOUR. It is the body’s reaction to food that causes the blood glucose level to drop which results in a low blood glucose reading, hypoglycaemia.

Weight gain is usually seen with insulinomas, whereas those with reactive hypoglycaemia do not usually develop this.

What are the symptoms of an insulinoma?

The main symptoms of an insulinoma are hypoglycaemia and weight gain. Hypoglycaemia means low blood sugar and will cause neuroglycopenia and autonomic nervous system symptoms. While hypo symptoms can vary from person to person the most common symptoms are below:

Early signs of a hypo include:

Sweating heavily

Feeling anxious

Trembling and Shaking

Tingling of the lips

Hunger

Going Pale

Palpitations

Feeling strange

If a hypo is not treated at this stage, symptoms can become more severe and include:

Slurring your words

Behaving oddly

Being unusually aggressive and tearful

Having difficulty concentrating

If hypos are not treated it may result in loss of consciousness or coma.

Please note: Hypos while driving can cause traffic accidents and it's important that people with insulinomas take steps to reduce the likelihood of having a hypo. Discuss this with your medical team. In some cases it may be necessary to suspend your driving licence while waiting for treatment.

Is there a recommended diet for Insulinomas?

Due to the rarity of this condition there is little research regarding diet. However the majority of those with an insulinoma find that a low GI diet helps to reduce the number of hypos and may also help to slow down weight gain.

The glycaemic index (GI) is a measure of how quickly foods that contain carbohydrates will raise blood sugar levels. A low GI diet consists of slow release carbohydrates to sustain normal blood sugar levels for longer.

High GI carbohydrates are released quickly in to the blood and are best avoided unless you are treating a hypo.

It is recommended that you eat every 2-3 hours having 3 main meals a day and 2 low GI snacks. Eat a snack before you go to bed to sustain blood sugar levels through the night.

While a low GI may help to prevent low blood sugar levels it can have no effect on the release of insulin from the tumour and you may still experience hypos until the tumour is removed.

Recommended low GI Foods:

Breakfast cereals based on oats, bran and wholegrain wheat such as porridge, All Bran flakes

Carbohydrates such as bread and pasta should be wholemeal and wholegrain

What can cause hypos?

Obviously if you have an insulinoma this will be the main reason for your hypos. However there are also other factors which can cause the hypos to be more often or severe:

Delayed or missed meal or snack

Not eating enough carbohydrates

Taking part in unplanned or more strenuous exercise than usual

Drinking alcohol without food

Heat from the weather, shower, baths or a day at the spa means that insulin is more effective and increases the risk of hypos.

In the case of insulinomas there is often no cause for a hypo but treatment for a hypo should always be carried out immediately.

Will I gain weight?

The majority of those with an Insulinoma will experience weight gain. The main reason is due to the number of excess calories consumed in order to stabilise blood sugar levels and treat hypos. In most cases the individual is unable to exercise as that can cause hypos due to rapid drops in blood sugar levels. It can also be dangerous to follow a weight loss plan while you are waiting for treatment.

Another reason for weight gain is the role of insulin in the body. Insulin causes glucose in the blood to be stored as fat. Weight gain occurs in 20-40% of insulinoma patients.

This can make you feel very depressed while you are waiting for a diagnosis and treatment. Try to remember that you are doing the right thing for your illness by not exercising or dieting and the most important thing is to maintain safe blood sugar levels.

After treatment, you will find that you will be able to follow a healthy eating plan and exercise normally. This and the return of normal insulin levels will help you to lose any weight gained.

What is Hypo Unaware?

Hypo Unawareness is a condition where people are unaware that their blood sugar is low or that they are having a hypo. This can be dangerous as a person may not experience any symptoms until they have severe hypoglycaemia.

If you think that you may be hypo unaware you will need to ensure that you check your blood sugar levels on a regular basis using a blood glucose monitor. If your blood sugar levels drop below 4 mmol/L (72 mg/dl) treat for a hypo as explained above.

Reduced Hypo Unawareness could be particularly dangerous when you are driving, operating heavy machinery and simple daily tasks such as cooking.

If you are experiencing hypo unawareness, discuss this with your GP or consultant. In some cases it may be necessary to surrender your driving licence until after treatment for the Insulinoma.

How do I get a diagnosis?

Getting a diagnosis for a rare condition can be difficult and so it is in the case of Insulinomas. A recent study indicates that it takes 15-36 months of symptoms before an Insulinoma diagnosis is considered. However we do know through the Insulinoma Network that for some it has taken years and a few false leads before finding an Insulinoma diagnosis.

The first step is to see you GP and ask for a fasting glucose blood test (the same type used to diagnose diabetes). If the blood glucose level is low ask your doctor to refer you to an Endocrinologist for further investigation.

If your doctor is not willing to refer you at this stage, we would recommend that you purchase a blood sugar monitor and take readings several times a day and when you think you might be having a hypo. Combine these with a food diary so that you can see a pattern and perhaps triggers for your hypos. If you are continually getting a reading below 4 mmol/L (72 mg/dl) despite eating a healthy diet then return to your doctor with your diary and ask for another fasting blood test based on the results and your food/blood glucose diary.

We would always recommend keeping a food diary with blood sugar results to provide empirical proof to the doctor or specialist. If you are experiencing hypos it may be difficult to be in the right frame of mind to explain or answer questions about your symptoms. Before you see your GP or specialist pick a time when your blood sugars are high and write down symptoms and experiences. You could also write down a list of questions. That way if your blood sugars are low during your appointment you will be prepared.

At this stage your GP should refer you to an endocrinologist for further investigation. If possible ask to be referred to an endocrinologist at a NET hospital as they are more likely to have knowledge of or have treated insulinomas.

To find a NET hospital in your area look at the following NET patient foundation website page:

The endocrinologist will take you through your medical history and symptoms and will then arrange tests to confirm diagnosis.

What tests will be used?

The following tests may be run:

The 72 hour fast. This is the most common test to be carried out initially and the reason for this is because 75% of those with an Insulinoma will develop symptoms within 18 hours of beginning the fast and 100% within 72 hours. The test is normally done as an inpatient. However in some cases the test is started at home with the patient going to hospital after several hours have elapsed. You will not be able to eat anything and will only be able to drink water. Patients are observed for symptoms and blood sugar readings and blood tests are taken on a regular basis to check blood glucose, C Peptide, Insulin and sulfonylurea levels.

To confirm a diagnosis your consultant would expect to see a low blood sugar (less than 2.8 mmol/l), a high insulin (6 microunits/ml or higher) and high levels of C peptide (0.2nmol/l or higher), an inactive amino acid that in a healthy body will be produced in equal amounts to insulin. Sulfonylurea tablets lower blood glucose levels and are used by diabetics. A diabetic may still have an insulinoma and be taking diabetic medication. If this is the case the doctor will be looking at the level of sulphonylurea in the blood in relation to insulin, blood sugar and C peptide levels. If it is normal an insulinoma will be suspected. The test for Sulfonylurea in non diabetic patients is still relevant to confirm if symptoms are from an insulinoma induced hypoglycaemia or sulfonylurea-induced hypoglycaemia.

If the blood test results of the fast suggest an insulinoma, one or several of the following tests will be carried out:

SRS Somatostatin Receptor Scintigraphy (Octreotide scan) – this is a common scan for NET patients. It can help to detect tumours that might be missed on other conventional scans. Around 50% of insulinomas have special receptors on their surfaces called somatostatin receptors. Octreotide is a somatostatin analogue, a substance that mimics the action of naturally occurring somatostatin. When Octreotide is combined with a mildly radioactive agent and then injected via a vein in the arm, it sticks to somatostatin receptors on the tumour surface and the tumours ‘light up’ on the screen as hot spots. This is a useful test to find out more about your tumours, where they are positioned, and also whether you would be suitable for certain treatments that use Octreotide or another chemical called Lanreotide as a carrier agent.

Ga-68 octreotate/octreotide PET scan – this is a new type of molecular imaging for NETs. It is much more sensitive than Octreotide scan, especially for small size tumours such as insulinomas. Also, it can be completed and provide very good quality images within hours, whereas Octreotide scan needs two days to be completed. Unfortunately, this new imaging modality is not widely available in UK yet.

CT scan – a computerised tomography (CT) scan provides a three dimensional picture of the inside of the body. It can be used to determine the position and size of tumours, and regular scans are useful to find out more about the rate of tumour growth and how your tumour is responding to treatment. When you arrive at the clinic you will probably be asked to drink a litre of fluid that contains a contrast agent that helps to highlight tumours, and you may also have a cannula inserted through which a special contrast dye is administered during the scan. These both help your specialists to read the scans more clearly as the tumours are highlighted.

MRI scan – this is a whole body scan. Magnetic resonance imaging (MRI) scans can help reveal where tumours are positioned. It uses magnetism rather than X rays to take pictures of inside the body. Scans can take up to one hour to complete and you have to stay very still inside the scanner lying on a couch. MRI is often used in conjunction with CT and SRS scans. They have a good value when detecting liver metastases (spread of tumour into the liver).

Endoscopic ultrasound (EUS) – is a technique that uses a special endoscope that has an ultrasound machine at the tip. Endoscopy refers to the procedure of inserting a long flexible tube via the mouth or the rectum to see the digestive tract, whereas ultrasound uses high frequency sound waves to produce images of the organs and structures inside the body such as the liver and pancreas. Using the EUS scope, doctors can place the ultrasound probe in the GI tract, close to the area of interest, so that a very detailed image of the deeper layers of the GI tract, surrounding lymph nodes, blood vessels, and organs can be obtained. Biopsies can also be taken at the same time. EUS is performed under sedation in the endoscopy unit. For detection of the primary tumour this procedure has a high sensitivity and accuracy level.

Portal vein sampling – there are other interventional tests that can be done if there is still doubt. A procedure that involves testing blood taken from the portal vein (that carries blood from the GI tract to the liver) following an injection of calcium (that stimulates insulin secretion) can reveal insulinomas smaller than 1cm. This test is called PVS (portal vein sampling) and is done under sedation.

How is an insulinoma treated?

Benign tumours (with no spread beyond the pancreas): Complete surgical removal of the insulinoma from the pancreas can provide a cure. Most patients have single tumours that can be totally removed - ‘enucleated’ - without even the need to cut away any part of the healthy pancreas. Sometimes this can be performed via keyhole surgery.

During surgery the specialist may perform an intraoperative ultrasound to ensure there is no other small tumours close by or any affected lymph nodes.

You will be given a glucose infusion throughout the surgery to ensure that you do not become hypoglycaemic. You may find that you are admitted the night before your surgery so that you can be on a glucose drip during the standard pre operative fasting stage.

Malignant tumours: It may be possible to surgically remove part of the pancreas, where the insulinoma is sited and remove any tumour which has spread to the liver.

You will be given a glucose infusion throughout surgery to prevent hypoglycaemia. You may be admitted the night before the operation so that you can have glucose during the standard pre operative fasting stage.

During surgery the specialist may perform an intraoperative ultrasound to ensure there is no other small tumours close by or any affected lymph nodes.

Surgery: The type of surgery that you have will be determined by the site of the insulinoma. If it is in the head you are more likely to have a Whipple procedure while if it is in the tail or the body you are more likely to have a distal pancreatectomy.

Pylorus Preserving Pancreaticoduodenectomy (PPPD): This takes out the head of the pancreas, your duodenum (the first part of your small bowel. Your gall bladder and part of your bile duct. The surgeon joins the remaining pancreas to the small bowel.

Whipple's Operation: This is the same as the above but part of the stomach is removed as well. It takes approximately four to eight hours.

Whilst both of these are major surgery the benefit is that you will keep part of your pancreas meaning that you may not need to take insulin nor digestive enzymes as you would if you had a total pancreatectomy. However as it is major surgery it will take a while to recover and your digestive system will need to adjust to its new way of working.

Total Pancreatectomy: This is major surgery in which the whole of the pancreas is removed. The duodenum, part of the stomach, the gall bladder, part of your bile duct, the spleen and surrounding lymph nodes are also removed. This operation is rare and as statistics suggest that a PPPD or Whipple have the same success of controlling cancer these are done instead. Losing your pancreas will affect your digestion and you will also become diabetic requiring insulin. You will also need to take digestive enzymes. The removal of the spleen may increase your risk of infection and you may need to have vaccinations and possibly antibiotics for the rest of your life. This surgery takes about eight hours.

Distal Pancreatectomy: If the insulinoma is in the body or tail of your pancreas you will be offered this surgery. The body and tail are removed and the head remains. Sometimes the spleen is also removed depending on its location with relation to the tail of the pancreas. As you will still have part of your pancreas left you should not need enzymes or insulin. However it is still a major operation and care must be taken afterwards. This surgery takes approximately four to six hours.

When you wake from the surgery you will most likely have a bladder catheter, and depending on the type of surgery may also have an epidural pain catheter, abdominal drainage tubes, an IV line for fluids and pain relief. You may have a feeding tube or IV or this may be inserted at a later date. You may also have a Nasogastric tube to remove stomach contents for a short while. You will also have an opening from the surgical site and drain sites which will leave scars. These scars will fade in time.

Possible complications of major pancreatic surgery: All of these operations involve major surgery and there are risks attached to them. Risks and complications will be explained to you by your surgical team before surgery and you can use this opportunity to ask any questions and address your concerns.

The most common complications are internal infection or abscess, fluid collection, bleeding, blood clots, fistula, chest infection and heart problems. Chest infection is a common complication of operations and you will be told by the nurses to breathe deeply and try to cough. The physiotherapy team will visit you in hospital and get you up and moving around as soon as possible to prevent chest infections.

Keyhole surgery: Keyhole (laparoscopic) Surgery is more likely to be used for distal pancreatectomys. Several small cuts are made on your stomach which the surgeon uses to pass a long narrow tube (laparoscope) and other instruments through. The laparoscope is connected to a fibre optic camera which projects images of the inside of the body onto a screen. The surgeon uses these images to remove the tumour

This type of surgery may cause less pain and the recovery time may be quicker. However this is still quite new surgery for insulinomas and therefore you may not be offered this type of surgery.

Post-operative care: This will vary depending upon the type of surgery that you have had. However you must remember that pancreatic surgery is major and you must give yourself time to heal. Full recovery can take from two to twelve months.

The average hospital stay after pancreas surgery is 3-10 days. You will be looked after by a multi disciplinary team which may include your surgeon, endocrinologist, physiotherapist, dietician, specialists in pain relief and if your tumour is malignant, an onocologist.

Pain and discomfort are normal after this type of surgery and you may be given intravenous pain medication initially and then moved onto oral pain relief before discharge.

After your operation you will have staples and dressings where incisions were made and you may have surgical drainage tubes in your stomach. Dressings will be checked and changed regularly. You may be discharged with surgical drainage tubes still in place. Do not worry if this is the case as you will be told how to take care of these sites and the drainage tubes will be removed by your surgical team or the district nurse at home when ready.

In some cases, the incision wound may open once the staples or stitches are removed. Again do not worry if you are discharged at this time. Arrangements will be made for the wound to be cleaned and the dressing changed daily either at your local medical facility or district nurse.

After surgery your stomach may be temporarily paralysed and you will not be given food during this period and limited fluids to allow the stomach time to heal. During this time you may be fitted with a Nasogastric tube which will safely remove any contents from your stomach. There is no way to know how long it will take for your stomach to regain its full function and this is a trial and error stage as you attempt to resume eating. Where necessary your hospital team will provide you with proper nutrition intravenously. You will not be discharged until you can eat and drink small amounts. It may take some while before your digestive system returns back to normal.

When you are discharged from hospital will depend upon a number of factors including support at home, being able to walk unassisted, tolerate food and liquid and have no unresolved health or surgical issues. The medical team will consult with you fully during this process so that they can address any issues or concerns you may have about returning home.

Once home, remember that a full recovery takes up to a year and you must make sure you rest and take pain medication on a regular basis. Gentle exercise such as walking is recommended. Consume food little and often so as not to put undue pressure on the operation site. The emphasis should be on consuming fluid and protein.

Your medical team will provide you with diet guidelines. It is recommended that easily digested foods are eaten initially. Examples of foods that are easily digested include eggs, well steamed vegetables, chicken, fish, soft cheeses and yoghurts. Foods to avoid initially include fibrous meats, raw fruit with skin, bananas and raw vegetables. If you feel bloated or nauseous eat small amounts of food and eat slowly. Take fluids in between and not with meals. High calorie nutritious drinks can help to reduce weight loss. Eat protein first as this is the nutrient that plays an important role in the healing process. It may also be advisable to take an over the counter multivitamin during this time. Check this with your doctor first.

After discharge you will have regular appointments with your medical team.

Medical management: In some cases surgery may not be possible and you will be prescribed tablets to control blood glucose levels and symptoms:

Diazoxide: This inhibits the secretion of insulin from the pancreas and can counter hypoglycemia. Side effects of Diazoxide include enema, weight gain, nausea and hirsute. You may also be prescribed Hydrochlorothiazide to overcome some of these side effects.

Calcium channel blockers have been used successfully, as they can inhibit insulin secretion. Many people who take calcium channel blockers to not have any side effects but those listed are flushing, headaches, swelling, constipation, nausea and dizziness.

Somatostatin analogues (octreotide) have been shown to provide only temporary or at best modest relief of symptoms. It is administered subcutaneously, intramuscularly, or intravenously. It may make symptoms worse by decreasing blood sugar further. Other side effects include diarrhea, constipation, stomach pain or discomfort, gas, bloating, nausea, vomiting; headache or dizziness.

For those with malignant tumours other treatments include:

Radionuclide targeted therapy – also known as magic bullet treatment is considered for patients who have advanced inoperable tumours that have positive uptake on the Octreotide scan. This treatment carries a radioactive particle e.g. Yttrium-90 or Lutetium-177 attached to Octreotide to wherever there are tumour cells (which have lit up on the Octreotide scan).

Transarterial chemoembolisation – may be considered if there has been spread of disease to the liver. This procedure involves cutting off the blood supply to the tumours with or without the addition of intra-arterial chemotherapy. Occasionally other ablation techniques such as radiofrequency ablation might be used if the tumours in the liver are small and few in number. This involves guiding a special needle electrode to the tumour and then passing a radio frequency current through it to heat the tumour tissue and ablate, or eliminate, it.

Chemotherapy – can be helpful for highly aggressive tumours that do not respond to other measures. Your NET specialist will advise you. The combination usually used is 5-fluorouracil plus cisplatin and streptozotocin.

New molecular treatments – Everolimus. Everolimus is a new oral agent, which belongs to the group of drugs that inhibit the ability of the neuroendocrine tumour to produce new vessels. There is now evidence that the drug is beneficial in patients with pancreatic neuroendocrine tumours and, according to two small published series of patients, it can improve the blood sugar levels, if other treatments have failed to do so. However, as this treatment may have some side effects, your NET specialist will advise you whether you are suitable for this drug.

Adriamycin and streptozocin can help to provide a remission from symptoms for eighteen months but their side effects are often worse than the hypoglycaemia.

What happens afterwards?

Benign: If your Insulinoma is benign the surgery should provide a total resolution of preoperative symptoms. Whilst there is a small chance that another insulinoma could grow this is very unlikely. However your endocrinologist will continue to see you and take blood tests and CT scans on a regular basis to ensure the pancreas remains clear.

Malignant: If your surgery was for a cancerous insulinoma you may also have the following treatments:

Chemotherapy - You may be given chemotherapy after surgery for pancreatic cancer. If all of the cancer was removed by surgery then chemotherapy may be used to lower the risk of the cancer returning. If some of the cancer remains after surgery the chemotherapy may be used to shrink what is left. In some cases chemotherapy is given before surgery to shrink the cancer so there is a greater chance of completely removing it through surgery. The chemotherapy drugs used include:

Fluorouracil (5-FU)

Capecitabine

Gemcitabine (Gemzar)

FOLFIRINOX combination chemotherapy

Radiotherapy - It is not often used in pancreatic cancer as it can also damage healthy cells and cause severe side effects. If the cancer cannot be removed with surgery or if you are not fit enough for the operation radiotherapy may be used to shrink or slow down the cancer.

Combined Radiotherapy and Chemotherapy: A combination treatment of Radiotherapy and Chemotherapy (chemoradiation) is sometimes used before surgery in cases of early pancreatic cancer. The aim is to shrink the cancer so that there is a great chance of removing it all in surgery and reduce the risk of recurrence. This dual therapy may also be used for locally advanced cancer that cannot be removed surgically.

Why do I feel this way?

Waiting for a diagnosis and before treatment

You may find that you feel sad, depressed and fatigued. It’s important to remember that insulinomas have a significant effect on your brain blood sugar levels resulting in neuroglycopenic effects. These include:

Moodiness, depression and crying

Negativism, irritability and rage

Personality change

Fatigue, weakness and apathy

Confusion, amnesia, and dizziness

As well as the above you may feel anxious and find stress difficult to cope with. You may also feel embarrassed about the condition and your “funny turns”. You might feel guilty that you are not preventing the hypos or are responsible for causing them.

Bear in mind that these are all symptoms of an illness. Not only are you trying to deal with the illness itself, managing hypos and maintaining blood glucose levels, you are trying to deal with these when your body and mind is already being compromised by the effect of low and fluctuating blood glucose levels.

Try and find ways to relax (stress can have a detrimental effect on blood sugar levels) that do not involve food and drink. Perhaps take up gentle yoga or Pilates (although check that the exercises are not too vigorous) to relax and settle you. Meditation may also help.

If possible try and find somebody that you can talk to about how you feel. Tell those people who may need to treat your hypos (such as your partner, boss, colleagues, friends or neighbours) about your hypoglycaemic symptoms and required treatment. Make sure that you always have a source of glucose on you (glucose gel, sweets, lucozade, glucose powder etc) which can be consumed easily and quickly. Also try and keep meal times regular with snacks two or three times a day.

Weight gain can affect your body image and make you feel depressed. By eating regular meals with snacks you may be able to limit the amount of weight you gain. However the most important thing to remember is staying safe and keeping blood glucose normal. If you find you do gain weight think about it as a symptom of your illness and one that will be resolved after treatment.

Having an insulinoma is a chronic condition. A chronic condition is a health condition or disease that is persistent or otherwise long lasting in its effects. The term is applied to those conditions which last for more than three months.

Those with chronic conditions may have to adjust their employment, aspirations and lifestyle and this may cause a period of grief. It can be difficult to diagnose depression in those with a chronic condition as the symptoms of the disease (in this case insulinomas) may be similar to symptoms of depression. By examining a patient’s risk factors for depression an accurate diagnosis may be made and action taken. It is important to diagnose and treat depression in those with chronic conditions to prevent a lack of motivation in looking after oneself and coping with pain and disease symptoms

The treatment for depression in those with a chronic condition involves using a combination of anti depressants, cognitive and supportive psychotherapies that incorporate awareness of the grief and loss that are consequences of the chronic condition.

If you think you may be depressed talk to your GP or consultant. They will be able to provide a treatment plan for you. The Mind website has further information regarding depression.

If you feel that you may harm yourself or that life is not worth living, call Samaritans on 08457 90 90 90 to talk to someone immediately.

Before and After Surgery

Before surgery you may feel elated that you finally know the cause of your symptoms and that it is going to be dealt with. It is natural to feel anxious before surgery and you will be able to discuss your concerns with your surgeon and anesthetists before your surgery. Depending upon the type of surgery you may find that you struggle during the recovery process and feel down and emotional. This is natural and will get better in time. Remember that you are getting over a major operation and this may affect your moods as well as any shock or trauma.

The good news is that now your brain has the blood sugar energy it needs to work fully you may find your thoughts clearer and moods brighter.

Malignant insulinomas: If your insulinoma is cancerous you will have a variety of thoughts and feelings. Remember that there is no right or wrong way to feel. You will deal with things in the best way for you.

After being diagnosed with cancer you will feel many emotions such as shock, upset and worry although some people feel relieved that they have had a diagnosis.

Your emotions may differ from one day to the next. You may feel negative about having treatment and may worry that you won’t be able to do things that you enjoy or asking yourself why has this happened to me? All these thoughts and feelings are natural. Don’t feel that you are weak for feeling this way. Try and find someone to talk to about how you feel. Your oncology team may be able to arrange counseling for you. Remember to ask friends and relatives for practical and emotional help.

Copyright and Content: Content on this site has been sourced from the NET Patient Foundation that supports people diagnosed with neuroendocrine tumours and their families.For further information visit: www.netpatientfoundation.com